Evaluation of the Incidence of Low Testosterone Levels in Young Male Adults with Moderate to Severe Obesity-Single-Centre Study from India.

PURPOSE: With the increase in obesity epidemic among Asians, it is necessary to evaluate the impact of obesity on this population. Low testosterone levels are known to be associated with obesity. This is the 1st study from Asia to evaluate incidence and magnitude of hypotestosteronemia in young adults with BMI more than 32.5 kg/m2 defined as moderate to severe obesity in Asians. MATERIALS AND METHODS: One hundred thirty-four male patients with BMI more than 32.5 kg/m2, between 18 and 30 years old who visited a single bariatric facility between 2017 and 2020, were evaluated with BMI, total and free testosterone levels and clinical features of gynecomastia, hypogonadism, and thinning of pubic and armpit hair. Statistical analysis was performed using SPSS, Spearman's correlation coefficient, and ANOVA test. RESULTS: 60.4% of patients (84/134) had low testosterone levels (< 300 ng/dl) and 23.9% (32/134) had levels between 300 and 400 ng/dl. 89.6% patients (120/134 had gynecomastia, 60.4% (81/134) had thinning of pubic and arm pit hair, and 62.7% (84/134) had hypogonadism. Testosterone levels showed a decreasing trend with increasing BMI, but it was not statistically significant. CONCLUSION: Obesity is one of the important etiologies of hypotestosteronemia and its manifestations in young adults. The actual incidence may be significantly higher than what is reported in the literature. High-quality research is required to address questions of diagnosis and best treatment options.

The Pharmacist's role in dermatology: Patient medication adherence.

Medication non-adherence is currently estimated to have caused at least 100 000 preventable deaths and over $100 billion in preventable medical costs. Adherence is particularly poor in dermatological conditions, with more than 50% of patients discontinuing topical treatments within the first year. Pharmacists are among the most accessible health-care professionals with the potential to greatly impact medication non-adherence through patient education, medication therapy management, and improved access to care. This review aimed to determine how pharmacists have improved medication adherence in dermatology and discuss strategies for further involvement. An extensive medical literature search using the PubMed database was conducted to evaluate clinical studies, published in the last 20 years, that have evaluated the pharmacist's role and impact on adherence of to dermatological products. PubMed search terms include: "pharmacists' role in dermatologic medication adherence", "pharmacist-led interventions in dermatology", "pharmacist medication adherence dermatology" and "pharmacist intervention dermatology". A total of 18 relevant studies were identified. Pharmacists improved dermatological medication adherence by increasing access to medications, providing medication counseling programs, and performing treatment monitoring services. However, corticophobia may contribute to pharmacists' hesitancy in making corticosteroid over-the-counter recommendations. Pharmacists are accessible health-care providers with the potential to improve dermatological medication adherence. Future advanced training in dermatology medications may refine pharmacists' knowledge of dermatological products.

Nontuberculous mycobacterial infection following cat scratch in the setting of topical steroid use.

Infections due to nontuberculous mycobacteria (NTM) are caused by mycobacterial species other than Mycobacterium tuberculosis, M. leprae, and M. bovis. Patients who are immunocompromised have increased susceptibility to pulmonary, lymphatic, and skin infections by these pathogens. We present a case of a 78-year-old male who presented to dermatology with a left dorsolateral hand infection after sustaining cat scratches in the setting of topical steroid therapy for suspected pyoderma gangrenosum. A shave biopsy of the lesion showed granulomatous dermatitis and associated acid-fast bacilli, while tissue culture grew Mycobacterium chelonae. This case demonstrates cat scratches as an uncommon risk factor for cutaneous NTM disease. Although an association between cat scratches and human NTM infections has only been reported in two previous cases, it must be considered in cases of unusual and persistent cutaneous lesions, especially in immunocompromised patients, even those with only local immunosuppression from topical agents.

Dermal Hypersensitivity Reaction to Semaglutide: Two Case Reports.

Glucagon-like peptide-1 (GLP-1) receptor agonists are a class of antidiabetic agents that work by inducing insulin secretion and inhibiting release of glucagon in a glucose-dependent manner. They are especially promising given their long duration of action, decreased risk of hypoglycemia, and added benefit of weight loss. Semaglutide is a GLP-1 receptor agonist that has been approved for type II diabetes and chronic weight management in obese adults. Cases of hypersensitivity reactions have been previously reported in patients taking GLP-1 receptor agonists dulaglutide and liraglutide. However, to our knowledge, there have been no reports of hypersensitivity reactions to semaglutide. Here, we present two cases of dermal hypersensitivity reactions in patients taking semaglutide for type II diabetes. In the first case, a 75-year-old woman who had been taking semaglutide for 10 months presented with an eruption on her legs, back, and chest for 3 months duration. Histology showed a subepidermal blister with eosinophils, suggestive of a drug hypersensitivity reaction. In the second case, a 74-year-old white man who had been taking semaglutide for 1 month presented with an eruption on the bilateral flanks and lower abdomen for 3 weeks duration. Histology revealed perivascular inflammatory cell infiltrate with eosinophils, also suggestive of a drug hypersensitivity reaction. Both patients began experiencing resolution of their symptoms within 1 month of discontinuing semaglutide. J Drugs Dermatol. 2023;22(4): doi:10.36849/JDD.6550 Citation: Ouellette S, Frias G, Shah R, et al. Dermal hypersensitivity reaction to semaglutide: Two case reports. J Drugs Dermatol. 2023;22(4):413-415. doi:10.36849/JDD.6550.

Smoke-Free Policies and Resident Turnover: An Evaluation in Massachusetts Public Housing From 2009‒2018.

INTRODUCTION: Smoke-free policies (SFP) in multi-unit housing are a promising tool for reducing exposure to tobacco smoke among residents. Concerns about increased housing instability due to voluntary or involuntary transitions induced by SFPs have been a primary barrier to greater widespread adoption. The impact of SFP implementation on transitions out of public housing in federally funded public housing authorities in Massachusetts was evaluated. METHODS: Tenancy data from the Department of Housing and Urban Development were used to determine the time from admission to transitioning out of public housing based on a cohort study design. Periods of exposure to SFPs were defined based on dates of SFP implementation at each PHA. Multi-level Cox regression models were fit to estimate the effects of SFPs on the hazard of transitioning, adjusting for household- and PHA-level characteristics. Analyses were conducted in 2021‒2022. RESULTS: There were 44,705 households with a record of residence in Massachusetts PHAs over 2009‒2018. Over this period, despite increasing adoption of SFPs among the PHAs, rates of transition remained steady at around 5‒8 transitions per 1,000 household-months. There was no overall association between exposure to SFPs and transitions among the full sample (adjusted HR=0.99, 95% CI=0.95, 1.04, p=0.794). However, the association varied significantly by age group, race/ethnicity, timing of SFP adoption, and era of admission. CONCLUSIONS: Adoption of SFPs in public housing had a minimal overall impact on turnover for households in Massachusetts, though disparities in the impact were observed between different demographic and PHA-level subgroups.

An analysis of lactate dehydrogenase (LDH) levels in advanced stage IV melanoma of the skin: prognostic capabilities and demographic variability.

Despite its limitations, in part due to decreased specificity in advanced disease, serum lactate dehydrogenase (LDH) is one of few serum factors used in cancer staging. This study quantifies the predictive capabilities of LDH in stage IV melanoma of the skin and explores the validity of suggested demographic discrepancies which may exist in its use. The 1975-2017 Surveillance Epidemiology and End Results (SEER) database was queried for stage IV cutaneous melanoma cases. Demographic characteristics were compared between LDH groups using chi-square and t tests. Subsequent Cox multivariable regression was performed to assess survival differences. 334 cases of stage IV cutaneous melanoma (average age: 63.0 years) with measured serum LDH levels were identified. Of these patients, 150 (44.9%) had normal LDH, 112 (33.5%) had LDH < 1.5 × upper limit of normal (ULN), 57 (17.1%) had LDH 1.5-10 × ULN, and 15 (4.5%) had LDH > 10 × ULN. Lower incomes were associated with higher LDH; individuals with incomes < $50,000 had the greatest proportion of LDH 10 × ULN (19.2%; p = 0.0031). LDH > 10 × ULN also had the lowest proportion of White patients (p = 0.04). On Cox multivariable survival analysis, increasing LDH levels showed increased risk of death (LDH < 1.5 × ULN: HR = 2.05, p = 0.01; LDH 1.5-10 × ULN: HR = 1.46, p < 0.001; LDH > 10 × ULN: HR = 5.91, p < 0.001). This study reaffirms the utility of LDH as a significant predictor of mortality with incremental severity, suggesting possible use for mortality projections. We note that Black patients and those with lower incomes may be more likely to have an elevated LDH. Older age groups and presence of ulceration among patients with stage IV melanoma were also associated with a greater risk of mortality.

Pancreatic Cancer Presenting to the Dermatology Clinic.

In patients with skin of color, jaundice may present more discretely, which can lead to a delay in diagnosing underlying disease and widening racial disparity gaps. It is important for clinicians to recognize the subtleties of jaundice to achieve the most optimal outcomes for patients. Careful examination of the sclera and palms, sites where yellowing is most obvious, as well as asking patients if they have noticed any skin color changes can be beneficial. We present a case of a patient who presented to the dermatology clinic with jaundice and pruritus refractory to standard treatment, ultimately leading to a diagnosis of pancreatic cancer.

Risk Factors Predicting Cellulitis Diagnosis in a Prospective Cohort Undergoing Dermatology Consultation in the Emergency Department.

Cellulitis is an infection of the skin and skin-associated structures with many clinical mimickers known collectively as pseudocellulitis. Dermatology or infectious disease consultation is considered the gold standard for diagnosis. We evaluated a prospective cohort of adult patients presenting to the emergency department (ED) with concern for lower extremity cellulitis who received dermatology consultation with conferral of a final diagnosis. Possible risk factors independently associated with cellulitis diagnosis (P<.1) were included in a logistic regression model for prediction of cellulitis diagnosis. Factors having odds ratios with a confidence interval excluding 1 were identified as significant independent predictors. The study identified factors that should be considered in evaluation of patients with suspected uncomplicated lower extremity cellulitis.

Bullous Pemphigoid Following the Moderna mRNA-1273 Vaccine.

As the onset of novel variants of the severe acute respiratory syndrome coronavirus 2 virus pushes policy-makers to push widespread vaccination efforts, it is likely that an increased number of severe cutaneous adverse reactions (SCARs) will present. Therefore, it is important to understand the presentation of possible SCARs. However, data are limited regarding which SCARs are most likely to be found following vaccination, and specific presentations in certain demographic groups, such as postmenopausal women, remain widely unknown. Here, we present the case of a 73-year-old female with no medical history or allergies presenting with a unique reaction of systemic bullous pemphigoid following the Moderna mRNA-1273 vaccine. To our knowledge at the time of this writing, based on a thorough review of the literature using PubMed, no such cases exist following the Moderna vaccine in the United States in elderly, postmenopausal women. We present a brief discussion on the presentation and management to hopefully alleviate future morbidity from similar reactions with increased distribution of the vaccine.

Implementation Activities in Smoke-Free Public Housing: The Massachusetts Experience.

A 2018 rule requiring federally-subsidized public housing authorities (PHAs) in the United States to adopt smoke-free policies (SFPs) has sparked interest in how housing agencies can best implement SFPs. However, to date, there is little quantitative data on the implementation of SFPs in public housing. Massachusetts PHAs were among the pioneers of SFPs in public housing, and many had instituted SFPs voluntarily prior to the federal rule. The aim of this study was to examine the adoption, implementation, and outcomes of SFPs instituted in Massachusetts PHAs prior to 2018 using a survey conducted that year. The survey asked if PHAs had SFPs and, if so, what activities were used to implement them: providing information sessions, offering treatment or referral for smoking cessation, soliciting resident input, training staff, partnering with outside groups, using a toolkit, and/or providing outdoor smoking areas. We used multivariable regression to investigate associations between implementation activities and respondent-reported policy outcomes (resident support, complaints about neighbors' smoking, and the number of violations reported per year). Of 238 Massachusetts PHAs, 218 (91%) completed the survey and 161 had an SFP prior to 2018. Common implementation activities were offering smoking cessation treatment/referral (89%) and information sessions for residents (85%). Information sessions for residents were associated with higher resident support (adjusted odds ratio [AOR] 4.3; 95%CI 1.2-15.3). Training staff (AOR 6.3, 95%CI 1.2-31.8) and engaging in ≥5 implementation activities (AOR 4.1, 95%CI 1.2-14.1) were associated with fewer smoking-related complaints. Utilization of multiple implementation activities, especially ones that informed residents and trained PHA staff, was associated with more favorable policy outcomes. We identified five groups of PHAs that shared distinct patterns of SFP implementation activities. Our findings, documenting implementation activities and their associations with SFP outcomes among the early adopters of SPFs in Massachusetts public housing, can help inform best practices for the future implementation of SFPs in multiunit housing.

Antibiotic resistance in dermatology: The scope of the problem and strategies to address it.

Antibiotic resistance is a growing health concern that has attracted increasing attention from clinicians and scientists in recent years. Although resistance is an inevitable consequence of bacterial evolution and natural selection, misuse and overuse of antibiotics play a significant role in its acceleration. Antibiotics are the mainstay of therapy for common dermatoses, including acne and rosacea, as well as for skin and soft tissue infections. Therefore, it is critical for dermatologists and physicians across all disciplines to identify, appropriately manage, and prevent cases of antibiotic resistance. This review explores dermatologic conditions in which the development of antibiotic resistance is a risk and discusses mechanisms underlying the development of resistance. We discuss disease-specific strategies for overcoming resistant strains and improving antimicrobial stewardship along with recent advances in the development of novel approaches to counter antibiotic resistance.

Clinical mimickers of calciphylaxis: A retrospective study.

BACKGROUND: Calciphylaxis is an ischemic vasculopathy with high morbidity and mortality. Early and accurate diagnosis is critical to management of calciphylaxis. Clinical mimickers may contribute to delayed or misdiagnosis. OBJECTIVE: To assess the rate and risk factors for misdiagnosis and to identify clinical mimickers of calciphylaxis. METHODS: A retrospective medical record review was conducted of patients with calciphylaxis at a large urban tertiary care hospital between 2006 and 2018. RESULTS: Of 119 patients diagnosed with calciphylaxis, 73.1% were initially misdiagnosed. Of patients not initially misdiagnosed, median time to diagnosis from initial presentation was 4.5 days (interquartile range, 1.0-23.3), compared to 33 days (interquartile range, 13.0-68.8) in patients who were initially misdiagnosed (P = .0002). The most common misdiagnoses were cellulitis (31.0%), unspecified skin infection (8.0%), and peripheral vascular disease (6.9%). Patients who were misdiagnosed frequently received at least 1 course of antibiotics. Patients with end-stage renal disease were less likely to be misdiagnosed than those without this disease (P = .001). LIMITATIONS: Single-center, retrospective study. CONCLUSIONS: Understanding the risk factors for misdiagnosis of calciphylaxis is an opportunity for further education concerning this rare disease.

What lies beneath: Cutaneous involvement of mantle cell lymphoma underlying an insect-bite-like reaction.

Mantle cell lymphoma (MCL) is an uncommon subtype of mature B-cell non-Hodgkin lymphoma characterized by specific morphologic, immunophenotypic, and genetic characteristics, namely the t(11;14)(q13;q32) chromosomal translocation with resultant cyclin D1 overexpression. MCL has a generally aggressive course and is often widely disseminated at the time of diagnosis. Skin involvement is exceedingly rare and is seldom the first manifestation of MCL. We present a case of MCL in an 84-year-old man with cutaneous involvement as the first manifestation, discovered incidentally after biopsy of a persistent nodule believed to be an insect bite. This case not only serves to raise awareness of the possibility of MCL presenting in the skin but also to point out that MCL can have lesions with both an insect-bite-like reaction and a deeper dermal MCL infiltrate.